Abstract
Introduction: There is a lack of data on the impact of sex on the outcomes of patients with heart failure (HF) undergoing atrial fibrillation (AF) ablation. Hypothesis: We hypothesized that outcomes of patients with HF undergoing AF ablation differ between males and females and tested this hypothesis using data from a nationally representative sample of the US population. Methods: The National Readmissions Database (NRD) was analyzed from 2016-2019 to identify patients ≥ 18 years old undergoing AF ablation. Patients were then divided into two cohorts based on their sex. A multivariable logistic regression model was used to adjust for confounders. Results: A total of 21,439 patients with HF underwent AF ablation between 2016-2019, of which 8,103 had heart failure with preserved ejection fraction (HFpEF) [64.8% were females], and 13,336 had heart failure with reduced ejection fraction (HFrEF) [38.4% were females]. Crude outcomes are shown in Figure 1. After multivariate adjustment, among patients with HFrEF, females had a longer length of stay (adjusted mean difference (aMD): 0.55 (0.16-0.93) days longer, p<0.01) along with lower odds of routine home discharge (adjusted odds ratio (aOR):0.62; 95% confidence interval (CI):0.55-0.70; p<0.01). Females had similar odds of in-hospital mortality, procedural complications, and 30-day/ 180-day all-cause, heart failure, and arrhythmia-related readmissions as compared to males. Among patients with HFpEF, females had higher odds of 30-day (aOR: 1.91; 95% CI: 1.24-2.93; p<0.01) and 180-day heart failure readmissions (aOR: 1.53; 95% CI: 1.04-2.28; p=0.03) along with lower odds of routine home discharge (aOR:0.67; 95% CI: 0.57-0.78; p<0.01), as compared to males. Conclusion: In conclusion, our results show that females with HFrEF undergoing AF ablation have similar odds of in-hospital/30-day/180-day outcomes whereas females with HFpEF have higher odds of 30-day/180-day HF readmissions, as compared to males.
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